1. Nutrition during Pregnancy and Lactation 1

2.  The mother’s food habits and nutritional status before conception, as well as during pregnancy, influence the outcome of the pregnancy. 2

3.  Mother needs more energy to:  Supply the increased fuel demanded by the fetus (increased metabolic workload)  Increase energy by 350 to 450 kcal/day (during 2 nd & 3 rd trimesters)  Increased complex carbohydrates and protein in the diet are the preferred sources of energy  The fetus requires glucose as its major source of fuel 3

4.  Protein serves as the building blocks for growth of body tissues during pregnancy.  Rapid growth of the fetus  Development of the placenta  Increased maternal blood volume  Amniotic fluid 4

5.  Protein intake should increase 25 g/day Increase by 50% Milk, eggs, cheese, soy products, meat Legumes, grains  Protein-rich foods contribute calcium, iron, B vitamins 5

6.  Calcium  Essential for fetal development of bones and teeth  Supplements might be needed in cases of poor maternal stores or pregnancies involving more than one fetus 6

7.  Iron * needed for Hemoglobin synthesis *consuming foods high in vit. C will help with iron absorption *Iron supplements often needed during pregnancy  Iodine Iodine essential to produce more thyroxine Sources Iodized salt 7

8.  Folate  Builds mature red blood cells during pregnancy  Needed during early pregnancy (and prior to conception)  DRIs recommend daily folate intake of 600 mcg during pregnancy and 400 mcg/day for nonpregnant women during childbearing years  May require folate supplements  TO PREVENT NEURAL TUBE DEFECTS !!! 8

9.  Neural Tube Defects 9

10.  Vitamin D  Ensures absorption and utilization of calcium and phosphorus for fetal bone growth, including teeth  Daily intake of at least 3 cups fortified milk (low fat, skim)  Exposure to sunlight increases synthesis of vitamin D 10

11.  Set weight goals according to mother’s pregnancy nutritional status and body mass index  Underweight women: 28 to 40 lb  Normal-weight women: 25 to 35 lb  Overweight women: 15 to 25 lb  Obese women: approximately 15 lb  Teenage girls: 35 to 40 lb  Women carrying twins: 35 to 45 lb  Women carrying triplets: overall gain of 50 lb  Minimum = 15 lb. 11

12.  Weight reduction should never be undertaken during pregnancy  Average amount of weight gain during first trimester: 2 to 4 lb  1 lb per week weight gain during remainder of pregnancy 12

13.  Pregnant women should avoid tobacco, alcohol and caffeine use during pregnancy and lactation  Less than 300mg caffeine/day may be acceptable, check with MD first !  Avoid: shark, swordfish, mackeral Higher levels of mercury Limit tuna (6 oz/wk), shrimp,salmon, catfish (12 oz/week) 13

14.  Undercooked meat, unwashed fruits/veget, Cat litter Toxoplasmosis (infection)  Mental retardation  Blindness  Epilepsy 14

15.  Nausea and vomiting  Morning sickness occurs briefly during first trimester.  Is caused by hormonal changes.  Small, frequent, dry, easily digested energy foods may relieve symptoms. Toast, crackers  Severe and prolonged sickness requires medical treatment (hyperemesis gravidarum) 15

16.  Constipation  May occur in latter part of pregnancy  The result of increased pressure of enlarging uterus and reduced normal peristalsis  Remedies include exercise, increased fluid intake, high-fiber foods  Hemorrhoids  Caused by increased weight of baby  Usually controlled by dietary suggestions used for constipation. 16

17.  Heartburn  Caused by pressure of enlarging uterus crowding the stomach  Dividing day’s food intake into a series of small meals usually relieves condition  Effects of iron supplements:  Gray or black stool, nausea, constipation, diarrhea  Take iron supplements 1 hour before or 2 hours after a meal with water or orange juice 17

18.  Identifying risk factors and addressing them early are critical.  Identifying poor food patterns can prevent nutrition problems.  Insufficient food intake  Poor food selection  Poor food distribution throughout day 18

19.  Teenage pregnancy  Special care must be given to support adequate growth of mother and fetus.  Teens have higher rates of low-birthweight infants & infant mortality  Concerns: still growing, no income, ? Smoking, ? Drug use, dieting, wt. gain fears 19

20.  Fetal alcohol effects 20

21.  Tobacco  Associated with prematurity and low birth weight  Drugs  Potential addiction in unborn child  Caffeine  Should avoid 21

22.  Special counseling needs  Vitamin abuse by megadosing also may cause fetal damage.  Caffeine used in extreme excess may result in fetal injury.  Poverty puts pregnant women in danger – will need resources for financial assistance & food (ie, WIC) 22

23.  Anemia  Deficiency of iron or folate in mother’s diet  Additional supplements may be required (beyond prenatal vitamins)  Neural tube defect  Caused by low folate intake  Intrauterine growth failure  Caused by low pregnancy weight, inadequate weight gain, smoking 23

24.  Hypertensive disorders (preeclampsia)  Related to diets low in appropriate kilocalories, calcium  Optimal nutrition important, medical treatment required  Gestational diabetes  Results from increased metabolic workload  Important to identify based on risk factors and treat with special diet or insulin 24

25.  Breastfeeding on rise since 1960  >70% of North American mothers currently initiate breastfeeding.  Goal = 75% in early post-partum period (2010)  More mothers are informed of benefits Practitioners recognize human milk can meet unique infant needs.  Maternity wards and birth centers support lactation. 25

26.  Milk production requires an extra 330 to 400 kcal/day.  Need for protein during lactation is 25 g/day more than woman’s average need.  About 3 L/day of water, juices, milk, and soup contribute to necessary fluids.  Rest, moderate exercise, and relaxation are necessary. 26

27.  Fewer infections  Fewer allergies and intolerances  Ease of digestion  Convenience and economy  Improved cognitive development  May protect against breast cancer (mom) 27